Sex-Based Analysis of Workflow and Outcomes in Acute Ischemic Stroke Patients Treated With Alteplase Versus Tenecteplase-Reference-Cited by-同舟云学术

Sex-Based Analysis of Workflow and Outcomes in Acute Ischemic Stroke Patients Treated With Alteplase Versus Tenecteplase

Published:2024-02 Issue:2 Volume:55 Page:288-295
ISSN:0039-2499
Container-title:Stroke
language:en
Short-container-title:Stroke

Author:

Kim Diana J.¹^ORCID,Singh Nishita²^ORCID,Catanese Luciana³^ORCID,Yu Amy Y.X.⁴^ORCID,Demchuk Andrew M.¹⁵⁶^ORCID,Lloret-Villas Mar I.⁷^ORCID,Deschaintre Yan⁸,Coutts Shelagh B.¹⁵⁶^ORCID,Khosravani Houman⁴^ORCID,Appireddy Ramana⁹^ORCID,Moreau Francois¹⁰,Gubitz Gord¹¹,Tkach Aleksander¹²,Dowlatshahi Dar¹³^ORCID,Medvedev George¹⁴^ORCID,Mandzia Jennifer¹⁵^ORCID,Pikula Aleksandra¹⁶^ORCID,Shankar Jai²^ORCID,Williams Heather¹⁷,Manosalva Herbert¹⁸^ORCID,Siddiqui Muzaffar¹⁹,Zafar Atif²⁰^ORCID,Imoukhuede Oje²¹,Hunter Gary²²^ORCID,Phillips Stephen¹¹^ORCID,Hill Michael D.¹⁵⁶,Poppe Alexandre Y.²³^ORCID,Ademola Ayoola¹⁶^ORCID,Shamy Michel¹³^ORCID,Bala Fouzi¹^ORCID,Sajobi Tolulope T.¹⁶^ORCID,Swartz Richard H.⁴^ORCID,Almekhlafi Mohammed A.¹⁵⁶^ORCID,Menon Bijoy K.¹⁵⁶^ORCID,Field Thalia S.²⁴^ORCID

Affiliation:

1. Department of Clinical Neurosciences, Cumming School of Medicine (D.J.K., A.M.D., S.B.C., M.D.H., A.A., F.B., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada.

2. Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada (N.S., J.S.).

3. Hamilton Health Sciences Centre, McMaster University, Hamilton, ON, Canada (L.C.).

4. Division of Neurology, Sunnybrook Health Sciences Centre (A.Y.X.Y., H.K., R.H.S.), University of Toronto, ON, Canada.

5. Department of Radiology, Cumming School of Medicine (A.M.D., S.B.C., M.D.H., M.A.A., B.K.M.), University of Calgary, AB, Canada.

6. Department of Community Health Sciences, Cumming School of Medicine (A.M.D., S.B.C., M.D.H., A.A., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada.

7. Division of Neurology, University of Alberta, Edmonton, Canada (M.I.L.-V.).

8. Department of Neurosciences, Université de Montréal, QC, Canada (Y.D.).

9. Division of Neurology, Queen’s University, Kingston, ON, Canada (R.A.).

10. Université de Sherbrooke, QC, Canada (F.M.).

11. Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (G.G., S.P.).

12. Kelowna General Hospital, BC, Canada (A.T.).

13. Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, ON, Canada (D.D., M. Shamy).

14. Royal Columbian Hospital, New Westminster, BC, Canada (G.M.).

15. London Health Sciences Centre, Western University, London, ON, Canada (J.M.).

16. Toronto Western Hospital (A.P.), University of Toronto, ON, Canada.

17. Queen Elizabeth Hospital, Charlottetown, PE, Canada (H.W.).

18. Medicine Hat Regional Hospital, AB, Canada (H.M.).

19. Grey Nuns Community Hospital, Edmonton, AB, Canada (M.S.).

20. St Michael’s Hospital, Toronto, ON, Canada (A.Z.).

21. Red Deer Regional Hospital, AB, Canada (O.I.).

22. University of Saskatchewan, Saskatoon, Canada (G.H.).

23. Centre Hospitalier de l’Université de Montréal, QC, Canada (A.Y.P.).

24. Vancouver Stroke Program, Division of Neurology, The University of British Columbia, Vancouver, Canada (T.S.F.).

Abstract

BACKGROUND: Understanding sex differences in stroke care is important in reducing potential disparities. Our objective was to explore sex differences in workflow efficiency, treatment efficacy, and safety in the AcT trial (Alteplase Compared to Tenecteplase). METHODS: AcT was a multicenter, registry-linked randomized noninferiority trial comparing tenecteplase (0.25 mg/kg) with alteplase (0.9 mg/kg) in acute ischemic stroke within 4.5 hours of onset. In this post hoc analysis, baseline characteristics, workflow times, successful reperfusion (extended Thrombolysis in Cerebral Infarction score ≥2b), symptomatic intracerebral hemorrhage, 90-day functional independence (modified Rankin Scale score, 0–1), and 90-day mortality were compared by sex. Mixed-effects regression analysis was used adjusting for age, stroke severity, and occlusion site for outcomes. RESULTS: Of 1577 patients treated with intravenous thrombolysis (2019–2022), 755 (47.9%) were women. Women were older (median, 77 [68–86] years in women versus 70 [59–79] years in men) and had a higher proportion of severe strokes (National Institutes of Health Stroke Scale score >15; 32.4% versus 24.9%) and large vessel occlusions (28.7% versus 21.5%) compared with men. All workflow times were comparable between sexes. Women were less likely to achieve functional independence (31.7% versus 39.8%; unadjusted relative risk, 0.80 [95% CI, 0.70–0.91]) and had higher mortality (17.7% versus 13.3%; unadjusted relative risk, 1.33 [95% CI, 1.06–1.69]). Adjusted analysis showed no difference in outcomes between sexes. CONCLUSIONS: Differences in prognostic factors of age, stroke severity, and occlusion site largely accounted for higher functional dependence and mortality in women. No sex disparities were apparent in workflow quality indicators. Given the integration of the AcT trial into clinical practice, these results provide reassurance that no major sex biases are apparent in acute stroke management throughout participating Canadian centers. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03889249.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Advanced and Specialized Nursing,Cardiology and Cardiovascular Medicine,Neurology (clinical)

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